The most commonly used drugs causing constipation are Vincristine, used regularly in the treatment of A.L.L. and solid tumours and Opiates such as Morphine used in supportive and palliative situations. These 2 drugs when used in combination have been shown to be of particular toxicity. [1]
Prevention
- Nutritional factors including adequate oral fluids, fruit and fibre as tolerated.
- Daily exercise, keeping as mobile as possible.
- Keeping a diary. Knowledge of drugs and side effects / timings and what factors tend to cause problems for individual patient.
- Medication: preventative group of drugs known as softeners eg lactulose / Movicol. [4]
Treatment
There is no good data on which to base the management of constipation in children and young people with cancer [2].
- Stimulants such as sodium ducusate (Docusol) or sodium picosulfate (Dulcolax) may be given and used alongside a softener and are safe for use in immunocompromised patients [3].
- Never give enemas or suppositories to immunocompromised patients as transient bacteraemia may occur and give rise to septicaemia.
- If mucositis or perianal tear is present analgesia may be necessary. This may be in form of local agent or oral analgesia
It is important to contact centre or Paediatric Oncology Outreach Nurse Specialists (POONS /key worker) if constipation is becoming unmanageable. A stool diary and Bristol stool chart [4] are useful means of feeding back information to them.
References
[1] Pashankar,F.D, Season, J.H, McNamara,J., Pashankar,D.S., Acute constipation in children receiving chemotherapy for cancer. J Paediatric HaematologyOncology. 2011 Oct 33(7) 300-303
[2] Phillips,R.S Gibson,F A systematic review of treatments for constipation in children and young adults undergoing cancer treatment . J Paediatric Haematology Oncology 2008Nov;30(11)829-830
[3] www.medicinesforchildren.org.uk
[4] www.continence.org.au>pages>bristol